Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4596 | PR |
NPI | 1083158828 |
---|---|
Provider Name | Orlando Cruz-Acevedo |
First Address | Mayaguez, PR 00682 |
Second Address | Mayaguez, PR 00682-1136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2016 |
Last Update Date | 13/12/2016 |